Pulmonary Nodules: Common Questions and Answers

Pulmonary nodules are often incidentally discovered on chest imaging or from dedicated lung cancer screening. Screening adults 50 to 80 years of age who have a 20-pack-year smoking history and currently smoke or have quit smoking within the past 15 years with low-dose computed tomography is associated with a decrease in cancer-associated mortality. Once a nodule is detected, specific radiographic and clinical features can be used in validated risk stratification models to assess the probability of malignancy and guide management. Solid pulmonary nodules less than 6 mm warrant surveillance imaging in patients at high risk, and nodules between 6 and 8 mm should be reassessed within 12 months, with the recommended interval varying by the risk of malignancy and an allowance for patient-physician decision-making. A functional assessment with positron emission tomography/computed tomography, nonsurgical biopsy, and resection should be considered for solid nodules 8 mm or greater and a high risk of malignancy. Subsolid nodules have a higher risk of cancer and should be followed with surveillance imaging for longer. Direct physician-patient communication, clinical decision support within electronic health records, and guideline-based management algorithms included in radiology reports are associated with increased compliance with existing guidelines.